Medicaid is a big black hole that will suck in Rick Scott

And unless he changes that by reforming Medicaid, Rick Scott will be a self-financed, $73 million bust.

It's an interesting position for a former hospital CEO accused by his rivals of defrauding Medicaid.

As program costs have soared during the recession, lawmakers have been slashing other programs and raiding reserve funds to pay for it.

That can't continue. By 2014, state projections show that Medicaid will take up a third of the pie on the budget chart. Soon it will begin moving into the piece of pie set aside for education. And that will be unpalatable, even to the most conservative legislators.

Kicking poor people out of the hospital is one thing. Messing with the PTA is quite another.

If Scott can't slash Medicaid, then he can't slash the budget and he can't slash taxes. And all the editorial boards get to call him a huckster and a fraud – a Charlie Crist minus the personality.

I think Scott will call a special session early next year to deal with Medicaid, similar to the special session Charlie called in 2007 to pass his disastrous property insurance reforms.

Let's wish Scott better luck.

He certainly would get a quick education in dealing with special interests, because there are plenty of them in a program this big.

About 15 percent of Florida's population — 2.8 million residents — are on Medicaid. More than 25 percent of all Florida children are covered by Medicaid, as are almost 45 percent of pregnant women and two-thirds of nursing home patients.

And in future years, ObamaCare will make even more people eligible.

Medicaid costs $20.2 billion this year and will cost $25 billion by 2014, according to state figures.

One problem is that the program traditionally has used the same fee-for-service system that is bankrupting Medicare.

Jeb Bush pushed through reforms that put Medicaid recipients in five counties — with Broward and Duval the largest — into managed care programs beginning in 2006. While controversial, a report by the University of Florida said this did keep costs down and improved health outcomes.

Most reforms call for expanding this system to the rest of the state.

But this is adamantly opposed by the Florida Medical Association, which pumped millions into Scott's campaign. Doctors say they already lose money on Medicaid patients because the reimbursement rate is so low.

Putting an HMO between them and the patients only would make matters worse because the HMO would have to take its cut, meaning even less for doctors.

The doctors prefer either the fee-for-service system or something called "medical home," in which a doctor manages a patient's care instead of a health-care company. One obvious reason is the doctors would be paid more money.

But there is a long-term payoff, the FMA argues, because the doctors would be more actively involved in managing patients' care.

"It's much easier to treat diabetics in the office rather than have them end up in a hospital emergency room where they have to amputate their feet,'' says Jeffrey Scott, general counsel for the FMA.

But the problem, he concedes, is that this could increase costs in the short-term, whereas lawmakers want to bring down costs now.

One such lawmaker is House Speaker Dean Cannon, who is pushing a tweaked version of Bush's reforms. He also is looking at a plan to partially shield Medicaid providers from medical malpractice lawsuits, perhaps with some form of sovereign immunity. That would encourage more doctors to take on Medicaid patients.

The plan nobody is talking about is Scott's campaign proposal to give poor people vouchers to buy private coverage. That's because the vouchers wouldn't be big enough for private insurers to take them. They would be like Confederate dollars after April 18, 1865.

This makes Cannon's approach the most viable, and for good reason. There is far too much fraud and far too little healing in Medicaid. Private providers are more motivated and in a much better position to clamp down on Dr. Happy's Pain Clinic.